Pericarditis + Pleural Effusion Flashcards
What is pericarditis
Pericarditis is inflammation of the pericardium.
Epidemiology of pericarditis
- Pericarditis accounts for up to 5% of presentations to the emergency department
- M>F
- Most common 20-50 years of age
Virus + Bacterial causes of pericarditis
- Coxsackievirus - moxt common cause
- Mumps
- Epstein-Barr virus (EBV)
- Cytomegalovirus (CMV)
- Varicella-Zoster virus (VZV)
- HIV
- TB
Other causes of pericarditis
- Dressler syndrome
- Connective tissue disorder
- Hypothyroidism
- Trauma
- AI disorders
RFs of pericardititis
- Male gender
- 20-50 years of age
- Previous MI
- Viral or bacterial infection
- Systemic autoimmune disorders
Pericardium
- 2 layers
- protects and restrains heart
- phrenic nerve
Pathophysiology of acute pericarditis
- Fluid + IC move from tiny BVs in fibrous and serous pericardium into intersitium of those layers - makes layer thicker
- Due to inflam of pericardium - effusion may develop in pericardial space - serous pericardium cant remove fluid as quickly as it comes in
Pericardial effusion features
pericardial effusion that is large enough to adversely affect heart function is called cardiac tamponade, which is potentially life-threatening. The heart is unable to pump properly, leading to a reduction in cardiac outpu
How long does acute vs chronic pericarditis last for>
Acute - few weeks
Chronic - more than 6 months
Signs of acute pericarditis
-
Pericardial rub
- Heard at the left sternal edge as the patient leans forward
- Extra heart sound of a to-and-fro character
- High-pitched or squeaky
- Diminished heart sounds: if there is large effusion
- Tachycardia
- Tachypnoea
Symptoms of acute pericarditis
- Pleuritic chest pain - relieved by leaning forward
- Hiccups
- Fever and myalgia
- Shortness of breath
- Peripheral oedema
ECG for pericarditis
widespread saddle-shaped ST-elevation (highly sensitive) and PR depression (highly specific) followed by T-wave flattening and eventual T-wave inversion.
Pericardial effusion ECG
low QRS complex voltage or electrical alternans (QRS complexes have different heights)
Other investigations for pericarditis
- Chest X-ray: “water-bottle heart”
- Transthoracic echocardiogram: ‘dancing’ heart as
- ESR and CRP:elevated secondary to inflammation
Acute idiopathic + Viral pericarditis management
- 1st line: NSAIDsandcolchicine are often both used together
- 2nd line: NSAIDs, colchicineandlow-dose prednisolone
Bacterial pericarditis management
IV antibiotics and pericardiocentesis (removal of fluid) with washout, culture and sensitivities
Cardiac tamponade management
Urgent therapeutic pericardiocentesis
Complications of pericarditis
- Pericardial effusion
- Myocarditis
- Constrictive pericarditis
Chronic pericarditis pathophysiology
- IC initiate fibrosis of serous pericardium - produces inelastic shell around heart - hard for ventricles to expand
- SV decreases over time - compensate HR increases
- Not as life threatening as cardiac tamponade
Clinical manifestations of chronic pericarditis
- Kussmaul’s sign: rise in jugular venous pressure and increased neck vein distension during inspiration
- Pulsus paradoxus: an exaggeration in the normal variation in pulse pressure seen with inspiration, such that there is a drop in systolic blood pressure
- Diffuse heart sounds
- Right heart failure signs
- Ascites
- Oedema
- Atrial dilatation
Investigations for chronic pericarditis
- CXR: small heart with/without pericardial calcification
- ECG: low voltage QRS
- ECHO: thickened calcified pericardium restricting the heart’s movement; small ventricular cavities
Management of chronic pericarditis
- May require complete resection of the pericardium
- Complications - Congestive HF
DDs of pericarditis
MYOCARDIAL ISCHAEMIA
pneumonia
pul embolus
